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General NPI Number Information
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NPI Number | 1598568263
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Entity Type | Organization
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Legal Business Name | JACOBSON DENTAL CORP
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 932 ADMIRAL CALLAGHAN LN
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City | VALLEJO
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State | CA
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Zip | 94591-3680
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Country | US
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Telephone | 707-794-2020
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Fax | 844-534-8464
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Provider Business Mailing Address
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Address Line | 1420 ROCKY RIDGE DR STE 320
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City | ROSEVILLE
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State | CA
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Zip | 95661-2835
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Country | US
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Telephone | 916-877-7450
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KUSHBOO KUMAR
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Credential |
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Telephone | 916-877-7450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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